Licence Appeal Tribunal File Number: 24-009499/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Frantz Bissainthe
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
VICE-CHAIR:
Julian DiBattista
APPEARANCES:
For the Applicant:
Francesco Blasi, Paralegal
For the Respondent:
Emily A. Schatzker, Counsel
Kara Ramnaraine, Counsel
HEARD: In Writing
OVERVIEW
1Frantz Bissainthe, the applicant, was involved in an automobile accident on March 18, 2022, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Co-operators General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline (“MIG”) limit?
ii. Is the applicant entitled to $2,855.50 for an orthopaedic assessment, proposed by Mississauga Rehab and Sports Clinic in a treatment plan/OCF-18 (“plan”) dated February 27, 2023?
iii. Is the applicant entitled to $3,963.64 for psychological treatment, proposed by E-Clinic United Healing in a plan submitted December 23, 2022?
iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant remains within the MIG.
4The applicant is entitled to treatment within the MIG limits.
5The applicant is not entitled to interest or an award under s.10 of Reg. 664.
6This application is dismissed.
ANALYSIS
The applicant remains within the MIG
7Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured sustains impairments that are predominantly a minor injury. Section 3(1) defines a “minor injury” as “one or more of a sprain, strain, whiplash